Physician Job Settings, the Four Basic Food Groups:

Congratulations!

You’re finally approaching the end of your residency! After slaving over hundreds of patients on the wards, taking calls, and sleeping very little, it’s your chance to escape and practice medicine “for real.” But wait, where do you go now? Have you thought about what life after residency means to you? What kind of job are you looking for as a physician?

It’s all about lifestyle

When it comes to your life in medicine, for most specialties, you’ll have a wide choice of where and how you practice medicine. There are many choices available, and each has it’s own unique pros and cons.

Academics. We’ve all been there. University or teaching hospital based work is interesting and challenging as well. You’ll get to continually hone your diagnostic skills as well as teaching and probably research as well. You’ll get the perks of being called faculty, and all the responsibilities that come along with it. Just picture yourself as your last attending and ask yourself if you could do that job.
Pros: Working at a more cutting edge facility, allows you to continue education, get to work with residents, can be a collaborative environment with peers and students, many perks (CME, university privileges, retirement program), Job stability.
Cons: Salary may be less than market value, may have relatively less direct patient care, schedule less flexible initially, have to deal with departmental politics.

Private Practice. You’ll get to be your own boss! Or join a group of other physicians in an office setting to take care of patients. Running your own office can be fun, rewarding, and sometime lucrative. Your practice of medicine will be your own style.
Pros: Be your own boss, flexible hours, run the office any way you want, office workflow is defined by you, more ownership of patients, hire and fire who you want, potentially greater financial rewards
Cons: May be rough starting out to gain patients, bigger headache initially with office setups and business decisions, have to take care of all the little office things, have to deal with office billing and insurance companies, must deal with your own call panel or pay others to take your calls.

Community Clinic. As residents we have rotated thru numerous free clinics and low income clinics. There is a great sense of purpose here, and it allows one to practice medicine in a place where people truly need help. You’ll have the benefit of a group of physicians working together for the common good of patient care.
Pros: Warm fuzzy feeling, true community outreach, usually nice patients, may take on community or public health leadership roles
Cons: Salary may not be competitive with market rates, patients may lack access to higher levels of care which can be frustrating, limited resources to provide care.

Locum Tenens. We all remember Doc Hollywood. As a locum physician, you’ll be asked to cover offices, clinics, hospitals for weeks to months at a time. This allows you to have great flexibility in your own lifestyle in terms of location and work area. You can use this to travel the country and experience life in areas of the country you might not normally live. Also, this may give you a taste of different practice styles of medicine that will allow you to decide what you want when you grow up!
Pros: Flexible to your schedule, lots of opportunities, many expenses paid for, may allow travel, no long term commitments needed
Cons: Usually temporary assignments, may not be available where you want to work, may require travel, may not have benefits.

For more on the subject, see the NEJM Jobs Article Differentiating Among Medical Practice Settings